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BCBSM Aims To Keep Claims Online

Carrier strives to keep billers and payors from reverting to paper post-HIPAA.

Intended as a measure to prevent partners from reverting to paper-based document transmission-rather than comply with the electronic transmission requirements of HIPAA-Blue Cross Blue Shield of Michigan (BCBSM, Detroit) has held a number of information sessions for customer groups, trade associations, billers and vendors.

"BCBSM currently has an electronic claims processing rate that is among the highest of health plans in the nation," reports BCBSM's CIO, William Smith. Eighty-five to 88 percent of claims received by BCBSM from physician offices and hospitals are sent and processed electronically. Additionally, 98 percent of prescription drug claims are processed electronically, according to Smith. "If we allow these organizations to revert back to paper, BCBSM will have huge operational issues and administrative costs" says Smith. "We can't allow that to happen."

Sense of Urgency

BCBSM hosted an informational session geared toward conveying a sense of urgency to billers and payors that the organization believes are not up-to-speed regarding the impact of HIPAA on their practices, Smith reports. Additionally, BCBSM prepared HIPAA-readiness updates and hosted statewide, face-to-face information sessionswith customer groups, trade associations and chambers of commerce. For its own employees, the carrier developed classes on the law's privacy provisions.

In anticipation of billers and payors being ready for compliance at different times, BCBSM built a dual operating environment that accepts both compliant and non-compliant transactions. The only third-party vendor piece of software within the environment, according to Smith, is Foresight's (Columbus, OH) Validator software. Smith explains that the online self-service testing tool is used by software vendors and developers who do business with the company to validate whether transactions meet HIPAA standards.

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